I think that if you nurse for a year that someone should have a party for you. The best I've been able to do is give out shirts. (http://bfmed.wordpress.com/2010/05/13/celebrating-the-journey/) I've given out more shirts than I can count now and I have a (now not-so-current) recognition list of of "one year" dyads on my website.
So, with all these moms in my practice reaching that goal, I began to consider doing something to recognize those mothers who continued to breastfeed to 18 months. Those wonderful moms, who took the shirt and the congrats at a year said "no thank you" when I mentioned what I was thinking about- they didn't want people to know. They'd nurse, but they didn't want public acknowledgement. They were "closet" nursers and ok with it.
The one year visit is also an opportunity to talk about the benefits of continuing to nurse after a year. I'm going to try not to call it "extended breastfeeding" since that reveals a cultural bias that exists where I live, but maybe not where you do. Worldwide, nursing two to four years is just normal. And before cultural biases interrupt the discussion, the AAP policy statement on "Breastfeeding and the Use of Human Milk" says that there "is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer."
So what happens at a year? Well, according to popular belief, as your beautiful breastfed child is sleeping the evening before their first birthday, their world gets rocked: the next day, they will discover that breastmilk serves no purpose. We have found a cow that makes better milk than mom.
How do you make a non-verbal one year old understand that? They are counting on that same warmth, expression of love and wonderful nutrition that they got the day before. What's magic about that 366th day of their life?
Now really, I know that doesn't make sense and the one year old is probably confused, but I know some wonderful women who believe that even if they are continuing to nurse, that the child still needs supplemental cow's milk "to get enough nutrients." I may live in "America's Dairyland" where we wear cheeseheads in public, but cow's milk is for cows. And since I'm usually having this conversation at a well visit, with the child right there, I can do a reasonable job of convincing the family that my physical exam suggests that their child is not a cow.
The infection fighting properties of breastmilk are still present; lysozyme, lactoferrin and secretory IgA are present in stable amounts. There are smaller levels of protein, calcium and long chain fatty acids when compared to the milk of a 3 month old, but we're aren't talking about a 3 month old, who is only getting breastmilk. Our toddler is getting complementary foods. Plus we know that moms who nurse longer lower their risk of breast cancer.
I get it. Many people, including most healthcare providers, don't understand why you'd want to nurse for more than a year. But they aren't the ones trying to calm a screaming 15 month old. I'm just saying- if I had to pick between the crying kid I need to distract and make happy somehow and the crying child who I can nurse and calm and get to smile in about 5 minutes, I'm picking the latter.
Someday, I'll be able to do something for my friends, the closet nursers, and I'll know we're making progress in my little slice of the world. Maybe then we can convince the rest of the world that nursing a toddler is normal.
Jenny Thomas, MD, IBCLC, FAAP, FABM
Because of multiple requests, "the" shirts and one that now says "Yes, I'm still breastfeeding" are available here. Or create your own. The point is to celebrate the journey!!!
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